tball -volunteerapp_12
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8/2/2019 TBall -volunteerapp_12
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LocaL League use onLy:Backron chck compl by la ocr ________________________________
on ____________________________________________________________________
System)s) used for background check (minimum of one must be checked):
Sx Onr Rsry Crmnal Hsory Rcors *LxsNxs
*Please be advised that if you use LexisNexis and there is a name match in the few states where
only name match searches can be performed you should nofy volunteers that they will receive a
leer directly from LexisNexis in compliance with the Fair Credit Reporng Act containing informa-
on regarding all the criminal records associated with the name, which may not necessarily be the
league volunteer.
Only aach to this applicaon copies of background checkreports that reveal convicons of this applicaon.
Lile League Volunteer Applicaon -2012Do not use forms from past years. Use extra paper to complete if addional space is required.
Plas ls hr rrncs, a las on o whch has knowl o yor parcpaon as
a volunteer in a youth program:
Name/Phone
______________________________________________________________________
______________________________________________________________________
AS A C ONditiO N Of vOLuNtee RiNg, i prmsson or h Ll La
oranzaon o conc backron chck(s) on m now an as lon as i conn o
b ac wh h oranzaon, whch may ncl a rw o sx onr rsrs,
chl abs an crmnal hsory rcors. i nrsan ha, appon, my poson s
cononal pon h la rcn no nappropra normaon on my backron.
i hrby rlas an ar o hol harmlss rom lably h local Ll La, Ll
La Basball, incorpora, h ocrs, mploys an olnrs hro, or any
ohr prson or oranzaon ha may pro sch normaon. i also nrsan ha,
rarlss o pros apponmns, Ll La s no obla o appon m o a
olnr poson. i appon, i nrsan ha, pror o h xpraon o my rm,
i am sbjc o sspnson by h Prsn an rmoal by h Boar o drcors orolaon o Ll La polcs or prncpls.
Applicant Signature _______________________________________da _________
i Mnor/Parn Snar___________________________________da __________
Applcan Nam(plas prn or yp) _______________________________________
NOTE: The local Lile League and Lile League Baseball, Incorporated will not discriminate
against any person on the basis of race, creed, color, naonal origin, marital status, gender, sexual
orientaon or disability.
A COPY OF VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BEATTACHED TO COMPLETE THIS APPLICATION.
Nam __________________________________ da ___________________
Address ________________________________________________________Cy ____________________________ State _________Zip _____________
Cll Phon Bsnss Phon
e-mal Arss:
da o Brh ____________________________________________________
Occpaon _____________________________________________________
Social Security # (manaory pon rqs or wh LxsNxs)____________________
employr _______________________________________________________
Address ________________________________________________________
Special professional training, skills, hobbies: ___________________________
_______________________________________________________________Commny alaons (Clbs, Src Oranzaons, c.):
_______________________________________________________________
Pros olnr xprnc (ncln basball/soball an yar):
_______________________________________________________________
do yo ha chlrn n h proram? Ys No i ys, ls ll nam an
wha ll? _____________________________________________________
Spcal Crcaon (CPR, Mcal, c.): ______________________________
do yo ha a al rr s lcns: Ys No
drrs Lcns#: ________________________________State ___________
Ha yo r bn conc o or pla ly o any crm(s): Ys No
i ys, scrb ach n ll: _________________________________________
_______________________________________________________________
Are there any criminal charges pending against you regarding any crime(s) involvingor aans a mnor? Ys No i ys, scrb ach n ll:________________________________________________________________________________
Ha yo r bn rs parcpaon n any ohr yoh prorams? Ys No
i ys, xplan: ___________________________________________________
_______________________________________________________________
in whch o h ollown wol yo lk o parcpa? (Chck on or mor.)
La Ocal Coach umpr fl Mannanc
Manar Scorkpr Concsson San Ohr
10211vOLuNteeR APPLiCAtiON 3/28/11
Jorge I. Saldana 2/24/2012
3100 Chino Hills Parkway #714Chino HIlls CA 91709
(909) 636-9979 (949) 505-4776
10/17/1980
Multimedia Design Specialist
620-09-6728
Panasonic
26200 Enterprise Way, Lake Forest CA. 92630
s
Jacob Saldana TBALL
D1550736 CA
s
s
s
Jamie Saldana / 909-636-9526 - Sofia Saldana / 626-347-4928
Miguel Saldana / 909-263-9405
2/24/2012
Jorge Saldana